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General NPI Number Information
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NPI Number | 1043834849
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Entity Type | Organization
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Legal Business Name | PADDINGTON PLACE, LLC
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 08/15/2024
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Provider Practice Location Address
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Address Line | 76 RACHEL STREET
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City | BIXBY
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State | OK
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Zip | 74008
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Country | US
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Telephone | 918-290-3401
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Fax | 539-302-9786
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Provider Business Mailing Address
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Address Line | PO BOX 990
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City | EDMOND
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State | OK
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Zip | 73083-0990
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Country | US
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Telephone | 405-285-8166
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Fax | 405-563-9447
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SCOTT D PILGRIM
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Credential |
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Telephone | 405-285-8166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number |
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License Number State |
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